Provider Demographics
NPI:1558075697
Name:JANES, DANA PAGE (PCLC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:PAGE
Last Name:JANES
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRIDGER PINES RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8605
Mailing Address - Country:US
Mailing Address - Phone:973-670-0263
Mailing Address - Fax:
Practice Address - Street 1:15 BRIDGER PINES RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8605
Practice Address - Country:US
Practice Address - Phone:973-670-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT56890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health